It is characterized by relapsing episodes of voracious appetite, during which the patient loses the control of the quantity of food taken. Then he provokes vomiting, uses laxatives and diuretics, and starts strict diets to make up for the excess.
Big meals can result in acute gastric expansion.
Self-induced vomiting can cause esophagitis, esophageal bleeding, and even rupture of the esophagus.
When induced vomiting is associated with a reduced awareness for the use of alcohol or drugs, aspiration pneumonia can occur.
Hypokalemia can be the result of vomiting and laxatives. There are cases of death for the abuse of ipecacuanha taken to induce vomiting.
Some people are susceptible to show an impulsive behavior, abuse of drugs and alcohol, and depression. Bulimia is enhanced by situations of psychosocial stress.
The treatment is based on psychotherapy together with antidepressant medication. With treatment discontinuations, there are often recurrences, so it is a chronic disease, sometimes difficult to control.
Advice on Bulimia nervosa
- When a patient shows frequent episodes of bulimia, we should very carefully advise him and treat not only his mental disorder, but also make him aware of the risks of his disease when driving.
- The bulimic patient, while driving, as he is alone and without witnesses, usually takes the opportunity to eat. However, taking food without control makes impossible safe driving, and increases the risk of causing an accident.
- If the driver cannot repress the bulimic episode, he should stop, to get calm, and if he does not control it, take the food without carrying out the driving activity that is dangerous for his life and that of others.
- We should let him know that alcohol and drug addiction disable him for driving. Until he has not stopped consuming with an appropriate therapy, driving is not recommended.
- Also, the side effects of antidepressants can make driving difficult. If the patient shows adverse symptoms due to drugs, he should notify his physician and adopt precautions when driving.
Night eating syndrome
It consists of morning anorexia, night hyperphagia, and insomnia.
Disorder characterized by an impaired sense of body image with marked weight loss, for an exaggerated fear of obesity.
The concern and the anxiety about weight, and the negation of the evident disease are the typical characteristics.
The patient has appetite. In fact, half of the patients with anorexia nervosa show episodes of bulimia and then provoke vomiting and self-administer laxatives and diuretics.
Bradycardia, hypotension, and edema are frequent, though disorders can appear in any main organ.
The most dangerous disorder are cardiac and electrolyte imbalances. Dehydration, metabolic acidosis and hypokalemia can occur.
Sudden death is not exceptional, and is frequently due to ventricular arrhythmia favored by hypokalemia.
They usually go to the physician for other intercurrent diseases or for the discomfort of the associated symptoms, such as constipation, abdominal disorders, etc.
The treatment of the patient with serious anorexia nervosa is based on stabilizing the nutritional and water-electrolyte status, together with antidepressant medication and, in many cases, subsequent psychiatric treatment of the patient and his family.
Advice on Anorexia nervosa
- The patient with anorexia nervosa generally controls well his actions, including driving, due to his intelligence and great activity.
- In the advanced phases of malnutrition, fatigue, and emaciation prevent from driving for the added risk of serious metabolic and cardiac complications.
- These patients do not want to be aware of the danger of their disease, and our advice should have psychiatric and family support.
- We should advise them not to drive until they have recovered from the severe malnutrition, and water-electrolyte balance has been achieved.
- The adverse events of psychiatric medication on the ability to drive are common. This should be warned to the patient and his family, so that they maximize precautions when driving.